Prognostic importance of MRI detected extramural venous invasion in rectal cancer: a literature review and systematic meta-analysis
Abstract
BACKGROUND
Extramural venous invasion (EMVI) is recognised to be a poor prognostic factor in rectal cancer. There are well documented limitations associated with pathology detection of EMVI, including variable reporting and the inability for it to be used preoperatively to guide neoadjuvant treatment. MRI detected EMVI (mrEMVI) has been proposed as an imaging biomarker. This review assesses the prognostic significance of mrEMVI on survival outcomes and whether regression of mrEMVI after neoadjuvant therapy is associated with improvements in survival.
MATERIALS AND METHODS
An electronic search was carried out using MEDLINE and EMBASE databases using the search terms 'rectum', 'cancer', 'MRI' and 'outcomes'. A systematic review and meta-analysis was carried out in accordance with PRISMA guidelines using RevMan software. A qualitative review was performed.
RESULTS
7399 articles were identified, of which 33 were relevant to the review question. Following a qualitative assessment, 20 articles were included in the meta-analysis. Baseline mrEMVI positivity is associated with significantly worsened overall survival (HR 1.84 [95% CI 1.33-2.54] p = 0.0001) and significantly worsened disease-free survival (HR 2.41 [95% CI 2.02-2.89] p < 0.00001). After neoadjuvant treatment, a positive mrEMVI status is associated with a significantly worsened overall and disease-free survival. Only 3 papers specifically looked at mrEMVI regression, but the results show that a persistent mrEMVI positive…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid.
Read the paper
Related studies
- Preliminary Toxicity Analysis of 3DCRT versus IMRT on the High Dose Arm of the RTOG 0126 Prostate Cancer Trial
- Adaptive Radiotherapy for Head and Neck Cancer: Initial Clinical Outcomes from a Prospective Trial
- American Association of Physicists in Medicine Task Group 263: Standardizing Nomenclatures in Radiation Oncology
- Motion Management Strategies and Technical Issues Associated with Stereotactic Body Radiotherapy of Thoracic and Upper Abdominal Tumors: A Review from NRG Oncology
- High-dose-rate interstitial brachytherapy as a monotherapy for localized prostate cancer: treatment description and preliminary results of a phase I/II clinical trial
- Highly efficient training, refinement, and validation of a knowledge-based plan quality control system for radiotherapy clinical trials
Go deeper in Evidence Hub
Evidence Hub adds a study data sheet (design, sample size, evidence level, key numbers), an AI summary and a chat grounded in the paper's text.